Albuquerque Lucas Alverne F, Macêdo Filho Leonardo José M, Borges Felipe S, Pessoa Fátima C, Diógenes Gabryella S, Rocha Cicera Jairlly V, Almeida João Paulo, Joaquim Andrei F
General Hospital of Fortaleza, Department of Neurosurgery, Fortaleza, Ceará, Brazil; University of Campinas, Department of Neurology, Campinas, São Paulo, Brazil.
Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
World Neurosurg. 2023 Sep;177:e563-e579. doi: 10.1016/j.wneu.2023.06.096. Epub 2023 Jun 28.
Despite the benefits of awake craniotomy (AC), many centers do not provide access to this service. We demonstrated the oncological and functional results of our initial experience in implementing AC in a context of resource-limited setting.
This prospective, observational, descriptive study collected the first 51 ACs for diffuse low grade glioma, classified according to the 2016 WHO classification.
Patient mean age was 35.9 ± 9.9 years-old. The most common clinical presentation was seizure (89.6%). Average segmented volume was 69.8 cc, and the largest diameter for 51% of lesions was more than 6 cm. Resection of more than 90% of the lesion was achieved in 49% of cases, and greater than 80% in 66.6% of cases. The mean follow-up was 835 days (2.29 years). Satisfactory Karnofsky performance status (KPS) (80 to 100) was observed in 90.1% pre-surgery, 50.9% at 5 days, 93.7% at 3 months, and 89.7% at 1-year post-op. In the multivariate analysis, tumor volume, new postoperative deficit, and the extent of resection were related to KPS at 1 year of follow-up.
Functional decline was clearly observed in the immediate postoperative period, but excellent recovery of functional status was observed in the medium and long term. The data presented indicate the benefits of this mapping in both cerebral hemispheres, addressing several cognitive functions in addition to motricity and language. The proposed AC model is a reproducible, resource-saving technique, that can be performed safely, with good functional outcomes.
尽管清醒开颅手术（AC）有诸多益处，但许多中心并未提供此项服务。我们展示了在资源有限的情况下开展AC的初步经验所取得的肿瘤学和功能学结果。
这项前瞻性、观察性、描述性研究收集了最初51例弥漫性低级别胶质瘤的AC手术病例，根据2016年世界卫生组织分类进行分类。
患者平均年龄为35.9±9.9岁。最常见的临床表现是癫痫发作（89.6%）。平均分割体积为69.8立方厘米，51%的病变最大直径超过6厘米。49%的病例实现了超过90%的病变切除，66.6%的病例超过80%。平均随访时间为835天（2.29年）。术前90.1%、术后5天50.9%、术后3个月93.7%、术后1年89.7%的患者观察到满意的卡诺夫斯基功能状态评分（KPS）（80至100）。在多变量分析中，肿瘤体积、术后新出现的功能缺损和切除范围与随访1年时的KPS相关。
术后即刻明显观察到功能下降，但中长期观察到功能状态的出色恢复。所呈现的数据表明这种脑图谱在两个大脑半球均有益处，除了运动功能和语言功能外，还涉及多种认知功能。所提出的AC模型是一种可重复、节省资源的技术，可以安全地进行，功能结果良好。
